Morbidity and Long-Term Follow-Up in CDH Patients

Overall survival of congenital diaphragmatic hernia (CDH) patients has increased since the widespread implementation of delayed operative repair with extracorporeal membrane oxygenation/gentle ventilation strategies starting in the mid-1990s. With the improvements in survival, CDH survivorship has been marked by increased morbidity with a greater need for monitoring and supportive interventions in infancy and early childhood. The multisystem morbidity and complexity of care for these patients mandate the dedicated resources and focus of medical specialties to ensure that the neurodevelopmental, cardiopulmonary, nutritional, and surgical sequelae of CDH are properly addressed. In this article, we will discuss the experience of CDH centers that offer long-term CDH follow-up as well as the patients' morbidities that require active monitoring until transition to adult care

Pulmonary function after early vs late lobectomy during childhood: a preliminary study

Background: One proposed reason for the early resection of asymptomatic congenital cystic adenomatoid malformations is the theoretical benefit of optimizing compensatory lung growth during infancy and early childhood. Our aim was to determine if early lobectomy is associated with better long-term pulmonary function then lobectomy later in childhood. Methods: A restropective chart review of children undergoing pulmonary lobectomy for benign disease from 1990 to 2006 was performed. Those having surgery before and after 2 years of age were compared. Forced vital capacity (FVC) and forced expiratory volume in 1 second (FEV1) were used as indicators of pulmonary growth, with FVC less than 82% predicted and FEV1 less than 80% consistent with impaired pulmonary function. Results: Of 115 patients identified, 14 had postoperative pulmonary function testing at a mean age of 10 years. Of these, 7 had lobectomy before and 7 had lobectomy after 2 years of age. There was no significant difference between groups in mean FVC (81.5 v 83.3) or the number of children with FVC less than 80% predicted, nor was there a difference in mean FEV1 (87.6 vs 82.9) or the number of children with FEV1 less than 80%. Conclusions: Age at the time of lobectomy did not influence FVC or FEV1. The preliminary data suggest that early lobectomy does not confer an advantage to the child with respect to long-term pulmonary function. A prospective study is necessary to confirm or refute these findings in a larger group of children. (c) 2009 Elsevier Inc. All rights reserved

Current status of in-vitro fertilization (IVF) in Hong Kong

link_to_subscribed_fulltex